PAEA Surgery End Of Rotation (EOR) Practice Exam

Which imaging modality is considered the best choice for the urological work-up of hematuria?

1. X-ray

2. CT urogram

3. Ultrasound

4. MRI

The correct answer is: CT urogram

The best choice for the urological work-up of hematuria is a CT urogram. This imaging modality is preferred because it offers excellent visualization of the urinary tract, including the kidneys, ureters, and bladder, allowing for detailed assessment of potential sources of bleeding. The high sensitivity of a CT urogram helps in detecting urinary tract stones, tumors, and other abnormalities that may be contributing to the hematuria. Additionally, it provides both anatomical and functional information with a rapid acquisition time, which is crucial in urgent clinical scenarios. The CT urogram can be performed with contrast enhancement, significantly improving the clarity of renal and vascular structures, thus aiding in the diagnosis of conditions like renal cell carcinoma or transitional cell carcinoma. In contrast, while other modalities like X-ray, ultrasound, and MRI can be valuable in certain contexts, they do not provide the same level of detail or comprehensive evaluation for hematuria. X-rays are limited in their ability to show soft tissue and are more useful for identifying calculi. Ultrasound is operator-dependent and may not reveal some pathologies that a CT urogram would. MRI, while excellent for soft tissue contrast and tumor characterization, is not typically the first-line imaging for hematuria due to longer acquisition times